Common use of CONTRACT REPORTS Clause in Contracts

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Report 4.18.3.7 Monthly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly Claims Processing Report 4.18.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 Monthly EPSDT Report 4.18.4.17 Quarterly Timely Access Report 4.18.4.1 Quarterly Provider Complaints Report 4.18.3.10 Monthly FQHC & RHC Report 4.18.3.9 Monthly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly Grievance System Report 4.18.4.5 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 Quarterly Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually “SAS 70” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly

CONTRACT REPORTS. 128 Report Contract Section Due Date Member Data Conflict Report 4.18.3.7 Monthly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly Claims Processing Report 4.18.4 4/18/2004 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 Monthly EPSDT Report 4.18.4.17 Quarterly Timely Access Report 4.18.4.1 Quarterly Provider Complaints Report 4.18.3.10 Monthly FQHC & RHC Report 4.18.3.9 Monthly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly Grievance System Report 4.18.4.5 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 Quarterly 4.18.6.6 Ad Hoc Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually 129 “SAS 70” Report & “SSAE 16” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually and anytime there is a change. State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc 4.18.4.20 Quarterly Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly Demonstration Reports See Attachments O and Q See Attachments O and Q Disclosure of Ownership and Control Interest Statement 8.6.5 and 31.20 Annually and within 35 days of any change in ownership of the Contractor Performance Measures 4.18.5.10 Annually Utilization Management 4.18.4.4 Quarterly Prior Authorization/Pre-Certification 4.18.4.9 Quarterly Pharmacy Audit Report 4.18.4.18 Quarterly Pharmacy Cost Report 4.18.4.19 Quarterly

CONTRACT REPORTS. Report Contract Section Due Date Member Information Report 4.18.2.1 Weekly Member Data Conflict Report 4.18.3.7 Monthly 4.18.2.2 Weekly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly 4.18.3.3 Monthly Claims Processing Report 4.18.4 4.18.3.4 Monthly System Availability and Performance Report 4.18.3.3 4.18.3.5 Monthly Utilization Management Report 4.18.3.6 Monthly Medical Loss Ratio Report 4.18.3.6 4.18.4.10 Quarterly Inpatient Expense Report 8.0 Monthly Physicians Expense Report 8.0 Monthly Pharmacy Expense Report 8.0 Monthly Outpatient Expense Report 8.0 Monthly Specialty Physician Expense Report 8.0 Monthly Utilization by Age Report 8.0 Monthly Enrollment Report 8.0 Monthly Large Claims Report 8.0 Monthly Claims Expense by Size Report 8.0 Monthly GME Payments Report 8.0 Monthly EPSDT Report 4.18.4.17 4.18.4.1 Quarterly Timely Access Report 4.18.4.1 4.18.4.2 Quarterly Provider Complaints Report 4.18.3.10 Monthly 4.18.4.3 Quarterly FQHC & RHC Report 4.18.3.9 Monthly 4.18.4.4 Quarterly Utilization Management Report 4.18.4.5 Quarterly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc 4.18.4.6 Quarterly Contractor Information Report 14.1.3 14.0 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 4.18.4.7 Monthly Grievance System Report 4.18.4.5 4.18.4.8 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 4.18.4.9 Quarterly Independent Audit and Income Statement 4.18.5.5 4.18.4.11 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 4.18.6.4 Quarterly Subcontractor Agreement Report 4.18.4.8 4.18.4.12 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 4.48.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually “SAS 70” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 4.18.6.2 Sixty Days after Contract Award; Quarterly; and Any time there is a significant change. Monthly or any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 4.18.6.1.3 Within 10 Days of verifications, also a verification Contractor Notifications 4.18.6.5 Within 10 Days of verifications Quarterly summary report Dental Utilization Hospital Statistical and Reimbursement Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly4.18.6.4 Upon request by Hospital Provider or DCH within 30 days of receipt of the request

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Report 4.18.3.7 Monthly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly Claims Processing Report 4.18.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 Monthly EPSDT Report 4.18.4.17 Quarterly Timely Access Report 4.18.4.1 Quarterly Provider Complaints Report 4.18.3.10 Monthly FQHC & RHC Report 4.18.3.9 Monthly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly Grievance System Report 4.18.4.5 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 Quarterly Independent Audit and Income Statement 4.18.5.5 Quarterly 189 Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually “SAS 70” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly

CONTRACT REPORTS. Contract Report Contract Section Due Date Member Information Report 4.18.2.1 Weekly Member Data Conflict Report 4.18.3.7 Monthly 4.18.2.2 Weekly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Page 156 of 233 Contract Report Section Due Date Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly 4.18.3.3 Monthly Claims Processing Report 4.18.4 4.18.3.4 Monthly System Availability and Performance Report 4.18.3.3 4.18.3.5 Monthly Utilization Management Report 4.18.3.6 Monthly Medical Loss Ratio Report 4.18.3.6 4.18.4.10 Quarterly Inpatient Expense Report 8.0 Monthly Physicians Expense Report 8.0 Monthly Pharmacy Expense Report 8.0 Monthly Outpatient Expense Report 8.0 Monthly Specialty Physician Expense Report 8.0 Monthly Utilization by Age Report 8.0 Monthly Enrollment Report 8.0 Monthly Large Claims Report 8.0 Monthly Claims Expense by Size Report 8.0 Monthly GME Payments Report 8.0 Monthly EPSDT Report 4.18.4.17 4.18.4.1 Quarterly Timely Access Report 4.18.4.1 4.18.4.2 Quarterly Provider Complaints Report 4.18.3.10 Monthly 4.18.4.3 Quarterly FQHC & RHC Report 4.18.3.9 Monthly 4.18.4.4 Quarterly Utilization Management Report 4.18.4.5 Quarterly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc 4.18.4.6 Quarterly Contractor Information Report 14.1.3 14.0 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 4.18.4.7 Monthly Grievance System Report 4.18.4.5 4.18.4.8 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 4.18.4.9 Quarterly Independent Audit and Income Statement 4.18.5.5 4.18.4.11 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 4.18.6.4 Quarterly Subcontractor Agreement Report 4.18.4.8 4.18.4.12 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 4.48.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually “SAS 70” Report 4.18.5.6 Annually Page 157 of 233 Contract Report Section Due Date Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 4.18.6.2 Sixty Days after Contract Award; Quarterly; and Any time there is a significant change. Monthly or any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 4.18.6.1.3 Within 10 Days of verifications, also a verification Contractor Notifications 4.18.6.5 Within 10 Days of verifications Quarterly summary report Dental Utilization Hospital Statistical and Reimbursement Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly4.18.6.4 Upon request by Hospital Provider or DCH within 30 days of receipt of the request

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Report 4.18.3.7 Monthly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly Claims Processing Report 4.18.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 Monthly EPSDT Report 4.18.4.17 Quarterly Timely Access Report 4.18.4.1 Quarterly Provider Complaints Report 4.18.3.10 Monthly FQHC & RHC Report 4.18.3.9 Monthly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly Grievance System Report 4.18.4.5 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 Quarterly 4.18.6.6 Ad Hoc Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually “SAS 70” Report & “SSAE 16” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually and any time there is a change. State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc 4.18.4.20 Quarterly Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly Demonstration Reports See Attachments O and Q See Attachments O and Q Disclosure of Ownership and Control Interest Statement 8.6.5 and 31.20 Annually and within 35 days of any change in ownership of the Contractor Performance Measures 4.18.5.10 Annually Utilization Management 4.18.4.4 Quarterly Prior Authorization/Pre-Certification 4.18.4.9 Quarterly Pharmacy Audit Report 4.18.4.18 Quarterly Pharmacy Cost Report 4.18.4.19 Quarterly

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Information Report 4.18.3.7 Monthly 4.18.2.1 Weekly Telephone and Internet Activity Report 4.18.3.1 Monthly 4.18.2.2 Weekly Eligibility and Enrollment Reconciliation Report 4.18.3.2 4.18.3.1 Monthly Prior Authorization and Pre-Pre- Certification Report 4.18.4.9 Quarterly 4.18.3.2 Monthly Claims Processing Report 4.18.4 4.18.3.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 4.18.3.4 Monthly EPSDT Report 4.18.4.17 4.18.4.1 Quarterly Timely Access Report 4.18.4.1 4.18.4.2 Quarterly Provider Complaints Report 4.18.3.10 Monthly 4.18.4.3 Quarterly FQHC & RHC Report 4.18.3.9 Monthly 4.18.4.4 Quarterly Utilization Management Report 4.18.4.5 Quarterly Quality Oversight Committee 4.18.4.6 Quarterly Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly 4.18.4.7 Quarterly Grievance System Report 4.18.4.5 4.18.4.8 Quarterly Cost Avoidance and Post 4.18.4.9 Quarterly Payment Recovery Report 4.18.4.6 Medical Loss Ratio Report 4.18.4.10 Quarterly Independent Audit and Income 4.18.4.10 Quarterly Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income 4.18.5.4 Annually Statement 4.18.5.5 Annually “SAS 70” Report 4.18.5.6 4.18.5.5 Annually Disclosure of Information on 4.18.5.6 Annually Annual Business Transactions 4.18.5.7 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and 4.18.6.2 Sixty Days after Contract Capacity Report 4.18.4.10 Award; Quarterly; and Any time there is a significant change. Third Party Liability and 4.18.6.1.3 Within 10 Days of Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterlyverification

CONTRACT REPORTS. ‌ Report Contract Section Due Date Member Data Conflict Report 4.18.3.7 Monthly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Pre- Certification Report 4.18.4.9 Quarterly Claims Processing Report 4.18.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 Monthly EPSDT Report 4.18.4.17 Quarterly Timely Access Report 4.18.4.1 Quarterly Provider Complaints Report 4.18.3.10 Monthly FQHC & RHC Report 4.18.3.9 Monthly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly Grievance System Report 4.18.4.5 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 Quarterly 4.18.6.6 Ad Hoc Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually “SAS 70” Report & “SSAE 16” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually and any time there is a change. State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc 4.18.4.20 Quarterly Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly Demonstration Reports See Attachmen ts O and Q See Attachments O and Q Disclosure of Ownership and Control Interest Statement 8.6.5 and 31.20 Annually and within 35 days of any change in ownership of the Contractor Performance Measures 4.18.5.10 Annually Utilization Management 4.18.4.4 Quarterly Prior Authorization/Pre-Certification 4.18.4.9 Quarterly Pharmacy Audit Report 4.18.4.18 Quarterly

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Information Report 4.18.3.7 Monthly 4.18.2.1 Weekly Telephone and Internet Activity Report 4.18.3.1 Monthly 4.18.2.2 Weekly Eligibility and Enrollment Reconciliation Report 4.18.3.2 4.18.3.1 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly 4.18.3.2 Monthly Claims Processing Report 4.18.4 4.18.3.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 4.18.3.4 Monthly EPSDT Report 4.18.4.17 4.18.4.1 Quarterly Timely Access Report 4.18.4.1 4.18.4.2 Quarterly Provider Complaints Report 4.18.3.10 Monthly 4.18.4.3 Quarterly FQHC & RHC Report 4.18.3.9 Monthly 4.18.4.4 Quarterly Utilization Management Report 4.18.4.5 Quarterly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 4.18.4.6 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly 4.18.4.7 Quarterly Grievance System Report 4.18.4.5 4.18.4.8 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 4.18.4.9 Quarterly Medical Loss Ratio Report 4.18.4.10 Quarterly Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 4.18.4.10 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually CONFIDENTIAL – NOT FOR CIRCULATION Independent Audit and Income Statement 4.18.5.5 4.18.5.4 Annually “SAS 70” Report 4.18.5.6 4.18.5.5 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 4.18.5.6 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 4.18.6.2 Sixty Days after Contract Award; Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 4.18.6.1.3 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterlyverification

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Report 4.18.3.7 Monthly Telephone and Internet Activity Report 4.18.3.1 Monthly Eligibility and Enrollment Reconciliation Report 4.18.3.2 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly Claims Processing Report 4.18.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 Monthly EPSDT Report 4.18.4.17 Quarterly Timely Access Report 4.18.4.1 Quarterly Provider Complaints Report 4.18.3.10 Monthly FQHC & RHC Report 4.18.3.9 Monthly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly Grievance System Report 4.18.4.5 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 Quarterly 4.18.6.6 Ad Hoc Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 Annually 183 “SAS 70” Report & “SSAE 16” Report 4.18.5.6 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 Annually and anytime there is a change. State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc 4.18.4.20 Quarterly Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterly Demonstration Reports See Attachments O and Q See Attachments O and Q Disclosure of Ownership and Control Interest Statement 8.6.5 and 31.20 Annually and within 35 days of any change in ownership of the Contractor Performance Measures 4.18.5.10 Annually Utilization Management 4.18.4.4 Quarterly Prior Authorization/Pre-Certification 4.18.4.9 Quarterly Pharmacy Audit Report 4.18.4.18 Quarterly Pharmacy Cost Report 4.18.4.19 Quarterly

CONTRACT REPORTS. Report Contract Section Due Date Member Data Conflict Information Report 4.18.3.7 Monthly 4.18.2.1 Weekly Telephone and Internet Activity Report 4.18.3.1 Monthly 4.18.2.2 Weekly Eligibility and Enrollment Reconciliation Report 4.18.3.2 4.18.3.1 Monthly Prior Authorization and Pre-Certification Report 4.18.4.9 Quarterly 4.18.3.2 Monthly Claims Processing Report 4.18.4 4.18.3.4 Monthly System Availability and Performance Report 4.18.3.3 Monthly Medical Loss Ratio Report 4.18.3.6 4.18.3.4 Monthly EPSDT Report 4.18.4.17 4.18.4.1 Quarterly Timely Access Report 4.18.4.1 4.18.4.2 Quarterly Provider Complaints Report 4.18.3.10 Monthly 4.18.4.3 Quarterly FQHC & RHC Report 4.18.3.9 Monthly 4.18.4.4 Quarterly Utilization Management Report 4.18.4.5 Quarterly Quality Oversight Committee Report 4.12.5.2 Ad-Hoc Contractor Information Report 14.1.3 Quarterly Subcontractor Information Report 16.0 4.18.4.6 Quarterly Fraud and Abuse Report 4.18.3.5 Monthly 4.18.4.7 Quarterly Grievance System Report 4.18.4.5 4.18.4.8 Quarterly Cost Avoidance and Post Payment Recovery Report 4.18.4.6 4.18.4.9 Quarterly Medical Loss Ratio Report 4.18.4.10 Quarterly Independent Audit and Income Statement 4.18.5.5 Quarterly Hospital Statistical and Reimbursement Report 4.18.4.11 Quarterly Subcontractor Agreement Report 4.18.4.8 4.18.4.10 Quarterly Performance Improvement Projects Report 4.18.5.1 Annually Focused Studies Report 4.18.5.2 Annually Patient Safety Report 4.18.5.3 Annually System Refresh Plan 4.18.5.4 Annually Independent Audit and Income Statement 4.18.5.5 4.18.5.4 Annually “SAS 70” Report 4.18.5.6 4.18.5.5 Annually Disclosure of Information on Annual Business Transactions 4.18.5.7 4.18.5.6 Annually State Quality Monitoring Report 4.18.6.1 Upon request by DCH Provider Network Adequacy and Capacity Report 4.18.4.10 4.18.6.2 Sixty Days after Contract Award; Quarterly; and Any time there is a significant change. Third Party Liability and Coordination of Benefits Report 4.18.6.1.2 Ad-Hoc Contractor Notifications 4.18.4.34 4.18.6.1.3 Within 10 Days of verifications, also a Quarterly summary report Dental Utilization Report 4.18.3.8 Monthly Case Management Report 4.18.4.12 Quarterly Disease Management 4.18.4.13 Quarterly Unclaimed Property Report 4.18.5.8 Annually Unclaimed Payment Report 4.18.5.9 Annually Health Check Record Review 4.18.6.7 Ad-Hoc Informing Activity 4.18.4.14 Quarterly CMS 416 4.18.4.15 Quarterly Initial Screen Report 4.18.4.16 Quarterlyverification